| Amazing Grace Treatment Center, Inc. | |
|
17 Indiana Ave Dayton OH 45410-2307 | |
| (937) 640-3400 | |
| Not Available |
| Full Name | Amazing Grace Treatment Center, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 17 Indiana Ave, Dayton, Ohio |
| Authorized Official Name and Position | Tyes'a Nelloms (PROGRAM MANAGER) |
| Authorized Official Contact | 9372318773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amazing Grace Treatment Center, Inc. 17 Indiana Ave Dayton OH 45410-2307 Ph: (937) 640-3400 | Amazing Grace Treatment Center, Inc. 17 Indiana Ave Dayton OH 45410-2307 Ph: (937) 640-3400 |
| NPI Number | 1043057482 |
|---|---|
| Provider Enumeration Date | 07/12/2024 |
| Last Update Date | 07/12/2024 |
| Certification Date | 07/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043057482 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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